Beginning April 1, 2018, CMS will be mailing out replacement cards for all Medicare beneficiaries with a Health Insurance Claim Number (HICN). The HICNs are being changed to Medicare Beneficiary Identifiers (MBIs) because the traditional Medicare numbers were based on Social Security Numbers. It is a step CMS is taking to help protect patient information. So what does this mean for providers?

What is the Medicare Beneficiary Identifier?

The Medicare Beneficiary Identifier (MBI) is an 11 character identifier made up of randomly generated characters (for example, 1EG4-TE5-MK73). While there are formatting rules about whether a number or a letter is in each position, there is no special meaning behind any of the characters. There will be no way to derive a Medicare number from existing demographic information. The patient will need to provide their correct number in order for the provider to bill appropriately.

Patient Communication

It is more important than ever to keep the lines of communication open with your patient. In the weeks leading up to the mail-out, you should review the HIPAA Eligibility Transaction System (HETS) report and ensure that the address is updated. If it is different than the patient address, talk to your patient or the patient’s caregiver and urge them to change their address with the Social Security Administration. They can revise their address online in the My Profile tab of their “my” Social Security account, call the Social Security Administration at 800-772-1213, or contact their local Social Security office. Patients who do not update their addresses may not receive their updated cards which can affect coverage of services after the transition period.

In July, 2017, CMS released their Medicare Card Messaging Guidelines with helpful tips on how to discuss these new MBIs with your patients. CMS has also published it’s mailing strategy online and will have a link to check the status of the card mailing on Medicare.gov starting in April, 2018. Once your patient receives their updated card, your clinician should get a copy to submit to the office to update billing information.

Billing Systems

To prepare for the transition, providers should make sure that their billing system and submission vendor can accommodate the new format of the MBI. Since the old HICNs could be up to 11 characters and the new MBI is also 11 characters, this should not be a problem. However, because of the way HICNs were formatted, some computer systems may be more rigid with the types of characters they will accept in these fields. Follow-up with your billing software vendor to ensure you will be ready.

Transition Period

The good news is providers have a long transition period to adjust to these new changes and assist their clients in getting updated MBIs. The transition period is scheduled to start April 1, 2018 (subject to adjustment if there are any issues with testing) and run through December 31, 2019. On or after January 1, 2020, providers will need to use the updated MBI numbers for claims.

Starting October 1, 2018, Medicare remittance advices will include the patient’s MBI number for all patients whose bills were submitted with their HICN number. Medicare has examples of remittance advice on their website. Your Medicare Administrative Contractor (MAC) will also have a lookup function on their secure web portal starting in June, 2018.

Be aware that any patients who qualify for Medicare on or after April 1, 2018 will be issued only an MBI number so it will be important to ensure your staff is educated and systems are ready.

CMS Fact Sheet

Need more information or clarification? CMS has come out with a Fact Sheet that includes all of the information above and more. These changes should only affect traditional Medicare Numbers (HICNs). Medicare Advantage Plans already code their identifiers without the use of the Social Security Number.

In Conclusion

All dates reported in this article are valid as of the date of its publication. Make sure you are signed up with your MAC for updated information as the implementation date gets closer. With a major change like this, it is possible that there could be a delay in some of the quoted implementation dates. We will keep you updated on any changes as we are informed of them.